Background

Background: ‘Candy cane’ syndrome and internal hernia are late complications of Roux-en-Y gastric bypass with overlapping presenting symptoms. The similarity in presentation poses a diagnostic challenge requiring high index of suspicion and thorough diagnostic workup. Here we present a series of 17 patients with preoperative diagnosis of candy cane syndrome who underwent laparoscopic resection of the candy cane. 13 out of the 17 patients were found to have large mesenteric hernia defects intra-operatively. Objective: To assess symptom resolution after resection and/or repair in patients who had ‘candy cane’ syndrome alone compared to those who had ‘candy cane’ syndrome plus internal hernia.

Methods

We conducted retrospective analysis of all patients who underwent resection of ‘candy cane’ between 2019 and 2021 after preoperative workup suggestive of ‘candy cane’ syndrome. Data was analyzed using Student's t test and χ2 analysis where appropriate

Results

All patients presented with abdominal pain with 40% having additional symptoms of nausea, vomiting, reflux or bloating. After resection, 3 out of 4 patients who did not have internal hernia had complete resolution of their symptoms while only 6 out of 13 patients with internal hernia had resolution of their symptoms.

Conclusions

Candy cane syndrome can cause persistent abdominal pain, nausea or vomiting after RYGB. Most patients have resolution of symptoms after resection however the presence of internal hernia in addition to candy cane syndrome seems to portend poor response to resection and raises the question of whether these symptoms are due to the hernia rather than the ‘candy cane’